Monkey see, monkey do, and monkey feel the pain

Dr van den Broek

In 1999 New Scientist reported on a painful experiment carried out on owl monkeys at the University of California. The monkeys were trained to work for their food by squeezing and releasing a pistol grip. If a monkey performed the action fast, it was rewarded by a morsel of food. Within a few months, the monkeys became reluctant to use their hands, showed "signs of pain and stiffness" and became "increasingly clumsy". Eventually they could no longer work the lever reliably in the required time.  The article continued, "When this happens to people we call it repetitive strain injury, or RSI."

But here's another explanation that might be put forward about the monkeys and their hands. Their pain and dysfunction had nothing to do with their work with the pistol grip. Rather, the monkeys' problems arose because of their hysterical beliefs about the causes of pain. Their monkey trade unions had deliberately fed them false information about the relationship between excessive use of pistol grips and pain in the hand. Their monkey doctors had fostered this belief and induced them to enter the sick role. There was really nothing wrong with their hands. The problem lay in their beliefs. What's more, goes this explanation, at the time of the experiment, these monkeys were all going through stressful periods in their lives _ getting married, looking after their elderly parents and renovating their homes. These mentally disturbed monkeys had displaced their emotional distresses into their arms.

Sounds crazy? Not according to the ideas put forward by Dr Yolande Lucire about the nature of RSI in her recent book, Constructing RSI: Belief and Desire, and outlined in a guest column on this page on October 10. "Occupational tasks, keyboards, posture, overwork, and overuse do not cause RSI, "  she says. Instead, it is "caused by the belief that all or some of these have the capacity to harm the body". These false beliefs arose because of hysteria generated by trade unions, the media and the medical profession.

Lucire writes as though RSI were a thing of the 1980s. Nothing, however, could be further from the truth. For example, a 1997 study undertaken in the Australian Public Service showed that eight out of 10 respondents using a computer had signs of RSI. Two out of 10 of these workers were in constant pain while they were working. Even more significantly, none of those who participated in the survey was on workers' compensation. Nine out of 10 people with symptoms did not intend to make a claim.

There is now a large body of evidence which supports the relationship between repetitive  motions at work and RSI.

In a 500-page review of all the quality evidence it could find on this subject, the United States National Institute for Occupational Safety and Health concluded that a large body of credible research exists to show that these disorders of the arm, shoulders and neck are work-related and caused by repetitiveness, force and work posture.  Interestingly, this definitive work is not cited in  Lucire's book. Further, an article in The British Medical Journal describes the distorted appearance of the tendons of people with RSI under light microscopy.

To try to substantiate her claim that RSI sufferers are either malingerers or victims of their own false, hysterical beliefs, Lucire cites a non-representative sample of 100 RSI sufferers she saw between 1984 and 1991, all involving compensation claims contested by insurance companies. She found that none had a physical problem but all had personal problems, including marriage, pregnancy, marital break-up, bereavement, death of parents, building a house, forming new relationships.

But this proves nothing exceptional about the claimants. These are the usual events in the lives of ordinary working people, whether or not they have RSI. Some "problems", such as getting married, would be regarded by most as joyous events.

In fact, RSI can be prevented but is hard to get rid of once you have it. This is why Lucire's views are so dangerous. If people believe, as she does, that RSI is a furphy, then they won't see the need to take preventive measures at the computer. Preventive measures include taking regular breaks from the computer as well as correct furniture and set-up, and finding the most comfortable postural positions.

It can be hard for someone who has never experienced discomfort of any kind to understand how others can end up in chronic pain. "I don't get problems, so why should anybody else? " is the line of thought.

But the pain from severe RSI can be excruciating. One woman who has had it for 13 years says, "The pain feels like it comes from your very bones. With me it started back in 1990 as a bit of an ache in my forearm. It began after an intensive period of typing at work. I assumed it would just go away when I took my holiday. But 12 months later the pain was so bad I couldn't work. I couldn't carry shopping and couldn't drive. Rest took the edge off it, but I've never been completely free of pain since."

When medical knowledge is incomplete about a problem, strange explanations tend to flourish. Take Tourette's syndrome, for example. Medieval reports ascribed the condition to possession by devils. More recently, Freudian psychoanalysis claimed it showed the danger of repressing anger.  However, it is now well understood that the syndrome has a physiological basis. So it's likely to be with RSI. Just because we don't presently fully understand the mechanism of an injury, it doesn't mean that it's all in the mind. Just ask the monkeys.

Dr van den Broek is president of the RSI and Overuse Injury Association of the ACT.

www.rsi.org.au

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